Abstract
Injury costing methods have become an important part of injury research. This chapter discusses the major conceptual frameworks used to guide costing studies and offers a brief guide to how one would go about costing injuries. Because some of the issues in costing are more technical than can be covered here, references to other texts in economic evaluation are provided.
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Notes
- 1.
Knowing the cost of the prevented injuries would help one know the maximum one should spend on safety. If the cost of particular safety investments exceeds the comprehensive costs of the injuries to be prevented, then money spent on safety would be better spent on other things that can do more to improve the human experience.
- 2.
Countries could also attract foreign direct investment through a race to the bottom. If they offer an institutional infrastructure that offers workers no recompense for occupational injury, then they allow multinational firms to move dangerous jobs into these poorly regulated environments. The additional economic benefits of jobs created by the race to the bottom are perverse benefits from allowing a high rate of occupational fatality. They are artificial from the social perspective, which would have to balance the gains to the economy against the workers’ losses from occupational injury costs that the international firm has offloaded to poor and vulnerable workers.
- 3.
Paradoxically, because medical services are a component of GDP, successful safety officers could (hopefully) lower GDP by replacing the high-priced services of trauma surgeons and emergency personnel with the lower-priced preventive services.
- 4.
Both health spending and development assistance figures are in current dollars for 2008 and are taken from http://data.worldbank.org/indicator.
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Appendices
Appendix 1: A Cost of Injury Calculation
In 2009, the Egyptian Ministry of Health conducted a household survey to measure the burden of road injuries (Egyptian Ministry of Health 2009). The respondents who had injuries were asked to describe the health care utilization and lost work and productivity that they endured. These parameters are listed below.
The Egyptian data revealed an annual age-adjusted rate of injuries of 1,271 per 100,000 population. Taking a hypothetical population of 1 million, this translates to a total of 12,170 injuries of all kinds. Road traffic injuries accounted for 35% of this burden, thus amounting to a total of 4,449 road traffic injuries. The data also reveal some of the details involved in estimating cost components. For example, estimated inpatient costs are the product of the probability of inpatient care × cost for those hospitalized, with an analogous expression for outpatient costs.
Parameter for patients who have experienced a road injury | Value | Distribution (interquartile range) |
Probability of inpatient care | A = 19.64% | |
Cost per inpatient stay (US$)a | B = $1,547 | 168–1,350 |
Probability of outpatient care | C = 65.87% | |
Cost per outpatient visit (US$) | D = $41 | 19–60 |
Probability of lost work | E = 48% | |
Duration of lost work for those who lose work | F = 39 days | 7–45 |
Median wage (US$) | G = 30/day | |
Probability of property loss | H = 24% | |
Value of lost property for those who lose property (US$) | I = $1,350 | 443–5,063 |
One can use the lettered parameters and the equations in the text to calculate the various costs of injury as follows:
Median | Total | 25%ile | 75%ile | |
Property loss | Total RTI × H × I = 4,449 × 0.24 × 1,350 | $1,441,476 | $473,000 | $5,406,000 |
Lost productivity | Total RTI × E × F × G = 4,449 × 0.48 × 39 × 30 | $2,473,573 | $444,000 | $2,854,000 |
Medical costs | Total RTI[(A × B)+(C × D)] = 4,449[(0.2 × 1,547) + (0.66 × 41)] | $1,495,532 | $206,000 | $1,377,000 |
Total | $5,411,581 | $1,122,000 | $9,637,000 |
From this exercise, one finds that the total cost of road injuries in Egypt amounts to approximately $5.4 million per year for a population of 1 million individuals, translating to a cost of $5.41 per person per year. If one were pursuing an advocacy strategy one would multiply $5.41 times the 79 million population count of Egypt to announce that road injuries cost Egypt $427 million and compare this to some other financial statistic like health spending ($8 billion) or overseas development assistance ($1.3 billion).Footnote 4
From a planning perspective, one could compare how much the $5.41 injury cost per citizen might be reduced against the costs of better road safety enforcement to reduce it. If better enforcement could be achieved by deploying one more police officer per 10,000 citizens and if this could reduce crashes by 21%, then one could justify spending $30 (median daily wage) times 365 days = $11,000 to balance against the roughly $1.10 per citizen saved (21% × $5.41).
Appendix 2: Sample of a Stated Preference Questionnaire Might Begin
Part 1: Description of blindness: Imagine only being able to see dark or light but not being able to make out faces, read books, or watch television. Walking safely would require you to learn to use a cane or guide dog. You would not be in any pain. Part 2: Suppose your son were weighing two job offers that both included rewarding work, good benefits, and opportunities for promotion. Both jobs are the same in every way except how much they pay and the risk that an on-the-job blinding injury would occur. Which option would you advise your son to take? Part 3: Choose the better option | ||
Attribute | Option 1 | Option 2 |
Chance of blindness after 1 year on the job | 1% | 1.1% |
Annual salary | $50,000 | $51,000 |
This choice would iterate about 20 or so times per respondent using various values | ||
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Bishai, D., Bachani, A.M. (2012). Injury Costing Frameworks. In: Li, G., Baker, S. (eds) Injury Research. Springer, Boston, MA. https://doi.org/10.1007/978-1-4614-1599-2_19
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